The BC Centre of Excellence in HIV/AIDS (BC-CfE) published an important study today in the globally respected Lancet medical journal. The study strongly reinforces the view that the benefits of highly active antiretroviral therapy (HAART) extend beyond treatment of the virus to significantly preventing the transmission and spread of HIV.
Recognized as the gold standard treatment for HIV, HAART uses a combination of drugs to stop HIV from progressing to AIDS, extends life expectancy, and significantly reduces HIV-related deaths in diagnosed individuals.
"The expansion of HAART treatment plays an important role in the health of British Columbians with HIV, preventing HIV transmission and maximizing public health resources," said Gordon Campbell, Premier of British Columbia. "Based on HAART's effectiveness and ongoing research at the BC-CfE, Canada's leading HIV/AIDS organization, the government of B.C. is investing in improving access to HAART through innovative programs such as the Seek and Treat initiative."
The new study, funded by the U.S. National Institute on Drug Abuse (NIDA), found that increased levels of HAART treatment were associated with a decrease in community viral load and in new HIV diagnoses across British Columbia, particularly in populations with a history of injection drug use.
"These study results reinforce the effectiveness of HAART in preventing transmission of HIV, and support extending the treatment as prevention model developed at the BC-CfE and now being rolled out in major centres in Canada, the U.S. and elsewhere," said Dr. Julio Montaner, study lead author and BC-CfE director. Montaner is also a professor and chair in AIDS research at the University of British Columbia and President of the International AIDS Society (IAS).
"This BC-CfE study suggests expanded HAART coverage may curb the spread of HIV," said NIDA Director Dr. Nora D. Volkow. "These findings are especially important when it comes to populations with a history of injection drug use, as we now have a tool to help reduce the spread of HIV among them."
Results of mathematical models have varied dramatically in their estimation of the potential impact of increased HAART coverage on HIV transmission, predicting anywhere from elimination to potential worsening of the HIV epidemic. Therefore, the present study was conducted to analyze, at the population level, the potential association between the expansion of HAART, viral load and new HIV diagnoses per year in a Canadian province with free access to HIV care. The population was then stratified for injection drug use status.
Data resulting from BC-CfE research showed that the number of individuals actively receiving HAART had a strong impact on overall viral load and new diagnoses in the community. As HAART coverage increased, new HIV diagnoses decreased; as HAART coverage stabilized, so too did viral load and new HIV diagnoses.
The expansion of HAART is proving to be an important prevention tool that complements efforts of community prevention programs in B.C. - programs working to educate people about HIV and deliver needle-exchange and harm reduction supplies for at-risk populations.
The study results align with the emphasis global leaders in HIV research, policy and advocacy place on early treatment to prevent transmission of HIV. Michel Sidibé, Executive Director of UNAIDS, the Joint United Nations Programme on HIV/AIDS, noted that treatment is a smart health investment, as it reduces HIV transmission, TB infection and maternal and child mortality within communities, and improves work productivity.
"The most recent evidence presented by the BC Centre for Excellence in HIV/AIDS and other leading research organizations supports these facts and tells us that we need to introduce treatment earlier," said Sidibé. "Treatment not only saves lives, it can be one of the most compelling prevention tools we have."
The B.C. government recently invested in a $48-million, four-year pilot project to provide HAART treatment to people in medical need, living with HIV, but not currently accessing the health system in Prince George and Vancouver. The program, called Seek and Treat, will improve access to HIV/AIDS medications among hard-to-reach populations in these two communities such as sex trade workers, injection drug users and men who have sex with men. The pilot is currently being evaluated as part of the BC-CfE's innovative research program, Seek and Treat for the Optimal Prevention of HIV/AIDS (STOP HIV/AIDS).
Currently, more than 33 million people worldwide are infected with HIV, at least 7,400 people become infected with HIV each day and nearly 5,500 die daily from an AIDS-related illness.